metlife dental fee schedule 2020 for providers

Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. HMo0?v:JzXc/Y~ 4$8#27t9hkG~NMf]n+tAk Wh._AkJ~Mm1.O]f.ixk% (ABT iE%Jz,3X6#N]W_Q.v(>2(0CH*vy!f( LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Dental Aetna Inc. and its affiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. RNa: If so, most services will be considered separately. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. WebCoordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. For Apple Health clients and clients of the Developmental Disabilities Administration. Or contact Member Services for coverage details. %PDF-1.4 % Download the Pharmacy Information Authorization form (13-835A). As a MetLife Vision customer you can access language The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Predeterminations may not be available in all states. )SI{ 0BO|cEs}Oq""TV}c`u-hSwi8J", %%EOF Search for a dentist by name, specialty, ZIP code or the number of miles you are willing to travel. endstream endobj 780 0 obj <>/Metadata 30 0 R/Pages 777 0 R/StructTreeRoot 55 0 R/Type/Catalog/ViewerPreferences 798 0 R>> endobj 781 0 obj <>/MediaBox[0 0 612 792]/Parent 777 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 782 0 obj <>stream WebAmount of every $100 in premiums used to pay for claims and administration for the year ending Dec. 31, 2017 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-PPO dentist. 0000001499 00000 n Questions? $10 to $50 to extract a tooth. ), If you choose a new PCD on the sixteenth day of the month or later, the change will go into effect two months afterward. Ooops!!! - MetLife 0qPWp:dW5 ;6V]BpJ#@DE"?Fo=+57]>>=@^{"p5yM~'A}t`)6ts(T^ `p]~@5zPn/VO=RB;#Gkj@!bg~7s}f Yes. Each main plan type has more than one subtype. If not, we will pay as the secondary payor. Under these circumstances, dental offices may see the need to adjust their fee schedules. WebBoth of our dental plans include: Comprehensive dental services, from preventive care to crowns, bridges and dentures No in-network deductibles and no waiting periods, including orthodontia for children and adults Worldwide coverage with a large nationwide network. WebJuly 1, 2022 to present Mobile anesthesia for dental services billing guide; Fee schedules. August 1, 2022 to present Neurodevelopmental centers billing guide, July 1, 2022 to July 31, 2022 Neurodevelopmental centers billing guide, July 1, 2021 to June 30, 2022 Neurodevelopmental centers billing guide, View all neurodevelopmental centers billing guides, July 1, 2022 to present Neurodevelopmental centers fee schedule, July 1, 2021 to June 30, 2022 Neurodevelopmental centers fee schedule, January 1, 2021 to June 30, 2021 Neurodevelopmental centers fee schedule, View all neurodevelopmental centers fee schedules, January 1, 2019 to March 31, 2019 Nondurable medical supplies and equipment billing guides, July 1, 2018 to December 31, 2018 Nondurable medical supplies and equipment billing guides, View all nondurable medical supplies and equipment billing guides, January 1, 2019 to March 31, 2019 Nondurable medical supplies and equipment fee schedule, April 1, 2023 to present Nursing facilities billing guide, January 1, 2023 to March 31, 2023 Nursing facilities billing guide, October 1, 2022 to December 31, 2022 Nursing facilities billing guide, View all nursing facilities billing guides, April 1, 2023 to present Orthodontic services billing guide, January 1, 2023 to March 31, 2023Orthodontic services billing guide, October 1, 2022 to December 31, 2022 Orthodontic services billing guide, View all orthodontic services billing guides, August 1, 2022 to present Outpatient hospital services billing guide, July 1, 2022 to July 31, 2022 Outpatient hospital services billing guide, April 1, 2022 to June 30, 2022 Outpatient hospital services billing guide, April 1, 2023 to present -- OPPS fee schedule, January 1, 2023 to March 31, 2023 OPPS fee schedule, October 1, 2022 to December 31, 2022 OPPS fee schedule, July 1, 2022 to September 30, 2022 OPPS fee schedule, April 1, 2022 to June 30, 2022 OPPS fee schedule, January 1, 2022 to March 31, 2022 OPPS fee schedule, October 1, 2021 to December 31, 2021 OPPS fee schedule, August 1, 2022 to present Outpatient rehabilitation billing guide, July 1, 2022 to July 31, 2022 Outpatient rehabilitation billing guide, January 1, 2022 to June 30, 2022 Outpatient rehabilitation billing guide, View all Outpatient Rehabilitation Program billing guides, July 1, 2022 to present Outpatient rehabilitation fee schedule, July 1, 2021 to June 30, 2022 Outpatient rehabilitation fee schedule, January 1, 2021 to June 30, 2021 Outpatient rehabilitation fee schedule, View all Outpatient Rehabilitation Program fee schedules, July 1, 2022 to present Pharmacy Special Services fee schedule, July 1, 2021 to June 30, 2022 Pharmacy Special Services fee schedule, July 1, 2020 to June 30, 2021 Pharmacy Special Services fee schedule, View all pharmacy special services fee schedules, May 1, 2023 to present - Physician-related services/health care billing guide, April 1, 2023 to April 31, 2023 Physician-related services/health care billing guide, January 1, 2023 to March 31, 2023 Physician-related services/health care billing guide, View all physician-related/professional services billing guides, April 1, 2023 to present Physician-related services fee schedule, January 1, 2023 to March 31, 2023 Physician-related services fee schedule, October 1, 2022 to December 31, 2022 Physician-related services fee schedule, View all physician-related/professional services fee schedules, January 1, 2023 to present Enhanced pediatric fee schedule, July 1, 2022 to December 31, 2022 Enhanced pediatric fee schedule, October 1, 2021 to June 30, 2022 Enhanced pediatric fee schedule, View all enhanced pediatric fee schedules, January 1, 2023 to present Enhanced adult primary care fee schedule, July 1, 2022 to December 31, 2022 Enhanced adult primary care fee schedule, October 1, 2021 to June 30, 2022 Enhanced adult primary care fee schedule, January 1, 2023 to present Opioid use disorder fee schedule, July 1, 2022 to December 31, 2022 Opioid use disorder fee schedule, July 1, 2021 to June 30, 2022 Opioid use disorder fee schedule, View all medication for opioid use disorder fee schedules, July 1, 2022 to present Conversion factors, July 1, 2021 to June 30, 2022 Conversion factors, July 1, 2020 to June 30, 2021 Conversion factors, Centers of Excellence: organ transplant facilities directory, April 1, 2023 to present Planned home births and births in centers billing guide, January 1, 2023 to March 31, 2023 Planned home births and births in centers billing guide, October 1, 2022 to December 31, 2022 Planned home births and births in centers billing guide, View all planned home births billing guides, January 1, 2023 to present Planned home births and births in centers fee schedule, July 1, 2022 to December 31, 2022 Planned home births and births in centers fee schedule, July 1, 2021 to June 30, 2022 Planned home births and births in centers fee schedule, View all planned home births fee schedules, July 1, 2022 to present Prenatal diagnosis genetic counseling fee schedule, July 2021 to June 30, 2022 Prenatal diagnosis genetic counseling fee schedule, July 1, 2020 to June 30, 2021 Prenatal diagnosis genetic counseling fee schedule, View all prenatal diagnosis genetic counseling fee schedules, January 1, 2023 to present Prescription drug program billing guide, April 1, 2022 to December 31, 2022 Prescription drug program billing guide, October 1, 2021 to March 31, 2022 Prescription drug program billing guide, January 1, 2023 to present Expedited authorization codes and criteria table, June 1, 2022 to December 31, 2022 Expedited authorization codes and criteria table, December 1, 2021 to May 31, 2022 Expedited authorization codes and criteria table, February 21, 2023 to present Private duty nursing for children billing guide, July 1, 2022 to February 20, 2023 Private duty nursing for children billing guide, October 1, 2020 to June 30, 2022 Private duty nursing for children billing guide, View all private duty nursing for children billing guides, January 1, 2023 to present Private duty nursing fee schedule, January 1, 2020 to December 31, 2022 Private duty nursing fee schedule, July 1, 2016 to December 31, 2019 Private duty nursing fee schedule, April 1, 2023 to present Professional administered drug fee schedule, January 1, 2023 to March 31, 2023 Professional administered drug fee schedule, October 1, 2022 to December 31, 2022 Professional administered drug fee schedule, View all professional administered drugs fee schedules, July 1, 2022 to present Prosthetic and orthotic devices billing guide, April 1, 2022 to June 30, 2022 Prosthetic and orthotic devices billing guide, October 1, 2021 to March 31, 2022 Prosthetic and orthotic devices billing guide, View all prosthetic and orthotics billing guides, July 1, 2022 to present Prosthetic and orthotics fee schedule, October 1, 2021 to June 30, 2022 Prosthetic and orthotics fee schedule, July 1, 2021 to September 30, 2021 Prosthetic and orthotics fee schedule, View all prosthetic and orthotics fee schedules, August 1, 2022 to present Respiratory care billing guide, July 1, 2022 to July 31, 2022 Respiratory care billing guide, October 1, 2021 to June 30, 2022 Respiratory care billing guide, July 1, 2022 to present Respiratory care fee schedule, October 1, 2021 to June 30, 2022 Respiratory care fee schedule, July 1, 2021 to September 30, 2021 Respiratory care fee schedule, April 1, 2023 to present Rural heath clinics billing guide, January 1, 2023 to March 31, 2023 Rural health clinics billing guide, October 1, 2022 to December 31, 2022 Rural health clinics billing guide, April 1, 2023 to present RHC encounter rates, January 1, 2023 to March 31, 2023 RHC encounter rates, October 1, 2022 to December 31, 2022 RHC encounter rates, April 1, 2023 to present RHC enhancement rates, January 1, 2023 to March 31, 2023 RHC enhancement rates, October 1, 2022 to December 31, 2022 RHC enhancement rates, October1, 2022 to present SBHS billing guide, July 1, 2022 to September 30, 2022 SBHS billing guide, October 1, 2021 to June 30, 2022 SBHS billing guide, July 1, 2022 to present SBHS fee schedule, October 1, 2021 to June 30, 2022 SBHS fee schedule, July 1, 2021 to September 30, 2021 SBHS fee schedule, January 1, 2023 to present Sleep centers billing guide, July 1, 2022 to December 31, 2022 Sleep centers billing guide, October 1, 2020 to June 30, 2022 Sleep centers billing guide, April 1, 2023 to present Sleep centers fee schedule, January 1, 2023 to March 31, 2023 Sleep centers fee schedule, July 1, 2022 to December 31, 2022 Sleep centers fee schedule, January 1, 2023 to Present Sterilization billing guide, October 1, 2022 to December 31, 2022 Sterilization billing guide, July 1, 2022 to September 30, 2022 Sterilization supplemental billing guide, Physician-related/Professional Services Billing Guide, Sterilization Consent Form (HHS-687) (English), Sterilization Consent Form (HHS-687) English large print, Sterilization Consent Form (HHS-687-1) (Spanish), Sterilization Consent Form (HHS-687-1) Spanish large print, 1, 2023to present Substance use disorder billing guide, January 1, 2023to March 31, 2023 Substance use disorder billing guide, October 1, 2022 to December 31, 2022 Substance use disorder billing guide, View all SUD (FFS outside BHO process) billing guides, July 1, 2022 to present Substance use disorder fee schedule, October 1, 2021 to June 30, 2022 Substance use disorder fee schedule, January 1, 2021 to September 30, 2021 Substance use disorder fee schedule, View all substance use disorder fee schedules, January 1, 2023 to present Substance-Using Pregnant People (SUPP) Program billing guide, February 26, 2023 to present Telemedicine billing guide, January 1. startxref By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Top 3 reasons to choose Aetna Dental Your choice of any licensed dentist, in or out of network, worldwide, including virtual providers 0000044706 00000 n endstream endobj startxref *Illinois members: State laws vary with regard to out-of-network benefits. If you are a participating provider with one or more dental benefit plans, you may want to negotiate with those $10 to $50 to extract a tooth. Contact Us. endstream endobj 4805 0 obj <>stream DNO (Dental Network Only) in Virginia is not an HMO. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Unlisted, unspecified and nonspecific codes should be avoided. 0000136750 00000 n Stay up-to-date with rate andbilling changes, and ProviderOne system changes. For step-by-step instructions on completing a PA, visit our Prior authorization (PA) page. Links to various non-Aetna sites are provided for your convenience only. For language services, please call the number on your member ID card and request an operator. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. 'u s1 ^ Information is believed to be accurate as of the production date; however, it is subject to change. For information related to withdrawal management services (previously detox), please see the agency's inpatient hospital guide. Notice: Past billing guides may have broken links. Discover the best option: HMO, PPO and TakeAlong Dental hb```b`b`e`eb@ !f(GBC S1(500;1T5~`;4a> O@s'IW5yLrWqcrED]:b53l 2& CEg 120bpg7E'21Jn- (o-ee` y.4 H30-f1p' `[ HOO1sj^ !CHTww`]%6x7A|!! 0000032811 00000 n 0000050892 00000 n "H9 !dQ &`,[f*#@$c VvDxAl@&FY`)g c WebCan I get an estimate of my out-of-pocket expenses? GEHA You can reach them at the number on your member ID card. Select one of the SafeGuard DHMO Plans or one of the MetLife You may still elect to receive services from a non CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. For telehealth policies and FAQs, see Telehealth on this page. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. endstream endobj 4793 0 obj <>/Metadata 104 0 R/Names 4814 0 R/Pages 4786 0 R/Perms/Filter<>/PubSec<>>>/Reference[<>/Type/SigRef>>]/SubFilter/adbe.pkcs7.detached/Type/Sig>>>>/StructTreeRoot 113 0 R/Type/Catalog>> endobj 4794 0 obj <>stream MetLife Preferred Dentist Program (PDP) Benefits 2022 Metlife - Member Dental Plan Benefits - Member Benefits 0000104077 00000 n CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Please contact Member Services. These rules determine The PCD has primary responsibility for managing your dental care. Just go to the Apple App Store or Google Play Store. Yes, but some plans may limit the benefit to certain teeth. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. [Company Name] Plan Benefits While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Hn@})R$R(8I1$o0Z?IT @m$,RRW$_yV? Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. The primary payor pays claims as it normally does. For previous versions, email us applehealthpharmacypolicy@hca.wa.gov. Jump to the first list item for each letter: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna Inc. and itsaffiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. H=o0w7S4oA2dhQ,QITEF}v@DN/8LBl^K]H*f:J]yDyS{dZ>L80|8xa@c7iCSY_yLdZ~2}e$LJV\+8CG09s^@wg8pn@\O9C3b\ O1^7TR6:'o9vS rp:QM{9l-k[[@szQV[*P/0chT}($^X'F-Bw)t]V[atF5]@R,hYxk,7Ge^AF*Ul. Bzb:5Gl8%bYYFMG`L"J/rrkBlF)ltPBVW oz If you had coverage under a previous insurance carrier, youll have coverage for certain services by that plan even after your Aetna coverage begins. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. Do you need a PA form? MetLife U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Dental insurance All Rights Reserved. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. required under the federal Americans with Disabilities Act of 1990 Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept".

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